Provider Demographics
NPI:1588853535
Name:CLAWSON, JODY SHAWN (APN)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:SHAWN
Last Name:CLAWSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:SHAWN
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:495 HOGAN LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8201
Mailing Address - Country:US
Mailing Address - Phone:501-327-5850
Mailing Address - Fax:501-327-4910
Practice Address - Street 1:495 HOGAN LN
Practice Address - Street 2:SUITE 2
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8201
Practice Address - Country:US
Practice Address - Phone:501-327-5850
Practice Address - Fax:501-327-4910
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y466Medicare UPIN